MS-III, seriously thinking about ENT

[staphaureus]

Hi all,

as my 3rd yr is winding up and I'm starting 4th year, I've had a change of heart and now seriously considering oto. I had some shadowing experience, but will be doing a 2 weeks oto rotation in early august (the only one available at this point).

I have a few questions:

1) If I work hard and managed to get a letter or rec, will 2 wks be enough?

2) Is it typical that everyone who applies to oto do away rotations? (I know it's true for ortho)

3) I'm a fairly average student during 1st-3rd year, had a lot of research experiences (non-oto research, a few pubs but non 1st author), with 240's score on step one. What can I do now, with only a month or two left, to improve my chances?

4) any motivational stories out there? I'm kicking myself in the butt for not doing the proper soul searching earlier.

thanks for all your help.

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[Leforte]

Q1: You should do a 4 week rotation. Two weeks is too short, IMHO. It does no allow you enough time to get to know all the faculty, follow cases, nor see the breadth of the field.

Q2: There have been various discussions about this in ENT. I am of the opinion that an away rotation usually hurts you more than it helps. All it takes is being late once, having some resident think your a jerk, being annoying in the OR and your chances at that place are close to nil. However, if you are a hard worker, always come early, stay late, are reading about cases and have an easy-going personality that most people get along with, I guess it couldn't hurt to do one. Your choice.

Q3: Get involved in some ENT retrospective chart review or other easy project that generates a lot of data in a short time. Stay away from the lab.

Q4: Only a few years ago we were an early match and our applications were in by this time. At least you now have a few extra months to figure things out. Stay humble on the interview trail, be pleasant to everyone, don't do anything odd during your interviews (I could give a few examples of some serious psychopathology I've seen in a few 20 minute interviews), and you should be fine.

 

[DrDre311]

Q1: You should do a 4 week rotation. Two weeks is too short, IMHO. It does no allow you enough time to get to know all the faculty, follow cases, nor see the breadth of the field.

Q2: There have been various discussions about this in ENT. I am of the opinion that an away rotation usually hurts you more than it helps. All it takes is being late once, having some resident think your a jerk, being annoying in the OR and your chances at that place are close to nil. However, if you are a hard worker, always come early, stay late, are reading about cases and have an easy-going personality that most people get along with, I guess it couldn't hurt to do one. Your choice.

Q3: Get involved in some ENT retrospective chart review or other easy project that generates a lot of data in a short time. Stay away from the lab.

Q4: Only a few years ago we were an early match and our applications were in by this time. At least you now have a few extra months to figure things out. Stay humble on the interview trail, be pleasant to everyone, don't do anything odd during your interviews (I could give a few examples of some serious psychopathology I've seen in a few 20 minute interviews), and you should be fine.

I agree with the above post except for the response to Q2. While it's true that you can f up just one time and hose yourself at one institution, aways are the best way to get good LOR's from VIP surgeons (critical to matching in a competitive field like oto). Aways also allow you to get perspective from multiple programs instead of viewing everything through the lens of your home program, and additional months let you figure out what you really like/don't like about the field as a whole--the upshot is that you'll be able to ask more intelligent questions on the interview trail (instead of asking bland questions that reveal the "I just wanna get in, I don't care where" attitude so prevalent in competitive specialties) and you'll be better able to make your rank list based on desirable program attributes. If you're concerned about screwing up your chances somewhere, then you shouldn't rotate at that institution; but I still recommend doing 2 4-week aways.

 

[5150]

I love that line by Pac. One of the best openings to a song ever.

 

[staphaureus]

thanks for replying everyone. This was really helpful. I know internship is going to be brutal and residency hours will vary depending on location, but in general, what is the resident schedule like, particularly towards the 3rd+ yr of residency (family planning reason).

 

[Leforte]

Longer hours for us in the senior years as you stay to continue operating on your longer cases. Juniors have primary call, but are also the first to go home earlier.

Also, you'll find that you spend more time at home involved in work-related activities as you go on in residency. You'll get more out of the surgeries you do and clinical patients you see if you spend time researching/studying/etc.

I average anywhere between 65-70 hrs in house. Some weeks (at outside places) are as little as 45 hrs, others are closer to 100.

We waited until I was finished with primary call before starting a family. Others started earlier - no time is really a good time in medicine, you just have to make a decision and roll with it.

 

[resxn]

aways are the best way to get good LOR's from VIP surgeons (critical to matching in a competitive field like oto).

And I'm one who disagrees with this. Having sat on selection committees at 2 university programs--one as a resident and one as an attending--I can say that for me and others, it was pretty obvious when a student got a letter from a "VIP" ENT during an away. In general, those letters are bland and weak. It's rare that they were glowing and demonstrated more than passing knowledge of the applicant.

I do agree that aways are probably the best way to get a feel for types of programs and some perspective on what you want from a program. However, in my experience, far far more subI's make me want to forget them rather than bring them in.

 

[DrDre311]

And I'm one who disagrees with this. Having sat on selection committees at 2 university programs--one as a resident and one as an attending--I can say that for me and others, it was pretty obvious when a student got a letter from a "VIP" ENT during an away. In general, those letters are bland and weak. It's rare that they were glowing and demonstrated more than passing knowledge of the applicant.

I do agree that aways are probably the best way to get a feel for types of programs and some perspective on what you want from a program. However, in my experience, far far more subI's make me want to forget them rather than bring them in.

I guess we'll have to agree to disagree on this one. My viewpoint is definitely colored by having gone through the hellacious PRS match, so maybe it's different in oto. When students sign up for away electives, they need to pick their battles. Rotating somewhere that routinely has 50 visiting students over the course of a given match cycle (UTSW and UC-Irvine come to mind) probably will not net you a great letter. Plus, once a student is on an away, it's necessary to go out of your way to spend significant time with a prospective letter writer instead of just showing up at the end of the month and having the guy say "Now, who are you again?"

Just like any other part of the application process, homework has to be done before signing up for aways; hopefully the chair/PD at the student's home institution would have some idea of who the better-known surgeons in the field are, and would be able to help the student select programs (with sufficiently well-known surgeons) that don't have a billion rotators.

As far as people hurting themselves on subI's, I certainly agree that this is possible especially when you're dealing with people who are too gung-ho/pushy or who think they're God's gift to surgery and don't work hard enough. The way to get around this is not to suck in the first place. Be smart, work hard, and be cool. Not too hard.

I interviewed at 23 programs and at every one I was asked about how many electives/away rotations I had done (to see just how much PRS I had pursued) and frequently asked how I liked working with Famous Surgeon X. I think aways are an important part of a competitive applicant's profile and mine definitely helped me match.

 

[HighPriest]

For whatever it's worth, of the four applicants to ENT at my university this most recent match year, at least three matched at the places they did aways (myself included). I'm honestly not sure about the fourth (though he did match). They also ranked their away rotations either first or second.

I can completely understand a bad rotation turning a program off towards you, which is why I would say the rule of thumb should be: if you don't plan on absolutely busting your @$$, then don't do the away rotation.

I'd also suggest doing a home ENT rotation FIRST, and then the away, preferrably without something candy@$$ed in between, so that you don't get lazy.

Worst case scenario: you don't like the program, they don't like you, but at least you know that.

That being said, most people obviously do not match at a place at which they did an away. So just know thyself and thyn work ethic, and choose wisely.

One last thing: If you've been frequently told that you're a jackass, or you notice that people tend to shy away from conversations with you, ya prolly shouldn't do the away either.

 

[staphaureus]

For whatever it's worth, of the four applicants to ENT at my university this most recent match year, at least three matched at the places they did aways (myself included). I'm honestly not sure about the fourth (though he did match). They also ranked their away rotations either first or second.

I can completely understand a bad rotation turning a program off towards you, which is why I would say the rule of thumb should be: if you don't plan on absolutely busting your @$$, then don't do the away rotation.

I'd also suggest doing a home ENT rotation FIRST, and then the away, preferrably without something candy@$$ed in between, so that you don't get lazy.

Worst case scenario: you don't like the program, they don't like you, but at least you know that.

That being said, most people obviously do not match at a place at which they did an away. So just know thyself and thyn work ethic, and choose wisely.

One last thing: If you've been frequently told that you're a jackass, or you notice that people tend to shy away from conversations with you, ya prolly shouldn't do the away either.

Thanks for the advice. I think I'm better inn person than on paper, but I simply don't have time to do an away rotation given that I have to do a rotation at my institution first. I'm just wondering if I need to consider taking a year off.

I guess this question is inevitable: 240's Step 1, A lot of research experience, few pubs (not first author and not in oto), did not honor surgery, honored IM and Psych. Not AOA. What are the chance of matching SOMEWHERE if I apply broadly, or would you personally just take a yr off?

 

[DrDre311]

Thanks for the advice. I think I'm better inn person than on paper, but I simply don't have time to do an away rotation given that I have to do a rotation at my institution first. I'm just wondering if I need to consider taking a year off.

I guess this question is inevitable: 240's Step 1, A lot of research experience, few pubs (not first author and not in oto), did not honor surgery, honored IM and Psych. Not AOA. What are the chance of matching SOMEWHERE if I apply broadly, or would you personally just take a yr off?

I would do away rotations. Make time for them. I can't comment on the utility of taking a year off, maybe resxn or one of the other oto guys could chime in on that one.

Not AOA and not honoring surgery are not good components of an app for a competitive specialty.

 

[resxn]

Thanks for the advice. I think I'm better inn person than on paper, but I simply don't have time to do an away rotation given that I have to do a rotation at my institution first. I'm just wondering if I need to consider taking a year off.

I guess this question is inevitable: 240's Step 1, A lot of research experience, few pubs (not first author and not in oto), did not honor surgery, honored IM and Psych. Not AOA. What are the chance of matching SOMEWHERE if I apply broadly, or would you personally just take a yr off?

your step I and your research will get you interviews. If you have strong letters, the rest is up to you and how well you interview.

 

[TheThroat]

A lot has already been written on what you should do (do a longer subI, do an away, etc). My advice:

-You have to do at least a month long subI at you home institution to get to really know some faculty and get some good LOR's. Oto is such a small field that most academics know other academics pretty well and while should get a chairman letter, if you can get a great letter from an oto faculty that you spend time, with, it can really help you out.

-In my opinion, academic types like bench/lab research better than little case studies or retro reviews. You prob won't get a pub out of it (I didn't), but you will be noticed if you spend a month in the lab and can talk about it coherently during your interviews.

-As far as aways go, I have written my opinion of them elsewhere and am not willing to fully regurg it here. I am not dead set against them, but I did not do one and don't think that you have to do one to get into a program.

 

[tbo]

-In my opinion, academic types like bench/lab research better than little case studies or retro reviews. You prob won't get a pub out of it (I didn't), but you will be noticed if you spend a month in the lab and can talk about it coherently during your interviews.

I'll recognize that this is 2 years old, but I think a lot of the "old" info here is still pretty valid and informative. To TheThroat or any others that can comment: It seems more intuitive to me that research experience prior to residency or even prior to being on faculty is really an exercise in knowing how to take a clinically-relevant problem, applying some level of investigative rigor to that problem, and producing results and contributing to the field. Granted, one can argue that a higher level of scientific rigor may be applied on the bench (ie. more variables can be reliably controlled for), but I would think the combination of producing (read: publishing) and showing (not telling) an understanding of the scientific method is the essence here. Or am I blowing hot air?